The common dressing forceps, it eunuch and fine enough in the handle, will. I In-lievc. be found the most;1 bullet extractor. That invented by Tnll'iiel 'ibl'm, acted well in the few cases in which I tried Ijarrey employed polypus >s in prctcn nee to anything else, but the inventions which have hern made to accomplish this simple did are innumerable. To support the limb with the disengaged hand on id'opposite to that at which we introduce the forceps, is of much importance. It' llic 000X86 of the ball has been from above downwards, and if it has approached at all near the surface, it should always be cut upon at the dependent part, by which two objects are secured the removal is facilitated, and an opening for the pus is insured.
If the wound be large, as it generally is from the conical ball, the finger forms tin.'. best probe, both to discover the ball, and also to examine the state of the adjoining parts j otherwise a large gum elastic boughie is our best resource. Causing the patient to move his limb, sometimes makes the site of the ball be felt by him, if not by us. Its position under a fascia, or in contact with a bone, would make us risk much in order to remove it. The contentment of mind which results from the extraction assists recovery amazingly. The long continuance of the discharge, its gleety character, and the persistence of pain in the track, almost always proceed from the presence of some foreign body it may be a mere shred in the wound.
Chloroform is of inestimable service to us, both in the examination of wounds, and in the removal of balls. All those voluntary muscular contractions which, although they are apt to interpose obstacles to our examination, were not presented to the entering ball, are done away with, and the severe pain which a prolonged examination and difficult extraction give rise to, is avoided. We must, however, be careful to obtain from the patient all the information he can give us, before we bring him under the influence of the anaesthetic. The inflammation which ensues in a gun-shot wound shortly after its infliction, makes itself visible in the swelling and consequent eversion of the lips of both entrance and exit wounds, in the general tumefaction of WOUNDS AND THEIR TREATMENT. the parts, and in the augmented pain.
It was the fear of this inflammation strangulating the which gave custom of scarifying the swelling will differ much in dim-rent regions and in different constitutions. In parts strongly bound down, in tissues, in lax distensil.le parts it will vary much, while, according as the patient is of an inflammatory, lymphatic, or nervous temperament, the effect will differ not a little. The constitutional fever which sets in is generally proportioned to the importance of the part implic though most anomalous exceptions do occur. This fever will often put on tin- characters of the endemic or epidein; e tt-ver; but in war the tendency seems generally to be to a low typhoid type, unless there be a decided influence in action, as that from paludal illegible in the scan of the first
This is common surgery, and ought also to be military surgery respecting gun-shot wounds." Uunlcr'i Collected: 549. F TIIK (KI.MKAX WAR. local inflammation, the prevention of all accumulations of matter by making judicious escapes for it, the relaxation of severed muscular fibre, the application of light iinirritating dressings, rest, and attention to the essential principles of all surgery, comprise the general treatment which gun-shot wounds usually demand. In the early stages cold may be of use locally even ice, as recommended by Baudens and in wounds of the hand and fore-arm irrigation is of the greatest service; but when inflammation and suppuration are present, hot applications will always be found of most good. Strict attention to the position of the limb is of great consequence, and though in general it may be desirable, as in some instances it is absolutely necessary, to restrict the diet, yet in those cases in which much suppuration is to be expected, very great latitude should be observed with reference to such a rule.